Fatigue, pain, and depression: an invisible triad among persons with spinal cord injury

Abstract

Background: Individuals with spinal cord injury (SCI) face an increased chance of secondary health complications. Fatigue, pain, and depression are among the most common of these complications, and may contribute to further disability post-injury. Prior cross-sectional studies have documented that fatigue, pain, and depression are correlated in patients with SCI, however there is a limited understanding of their temporal relationships.

Objectives: To examine the temporal relationships between fatigue, pain, and depression in persons with SCI.

Methods: This study is a prospective cohort study. Participants with SCI were recruited upon admission to an inpatient rehabilitation unit. Fatigue (Fatigue Severity Scale), pain (Brief Pain Inventory), and depression (Centre for Epidemiological Studies–Depression scale) were assessed at three points: baseline (within one week of admission), at the time of discharge, and into the community at six months post-discharge. Structural Equation Modeling was performed to test the directional relationships over time.

Major findings: The association between fatigue, pain, and depression grew in magnitude over time in the SCI rehabilitation. Pain at baseline and depression at discharge best predicted fatigue at discharge. Pain at baseline also predicted depression at discharge, which had an indirect effect on fatigue. Fatigue at follow-up was poorly predicted by baseline and discharge variables.

Conclusion: The present longitudinal study suggests temporal relationships whereby pain is followed by later depression and fatigue. These findings will allow clinicians to more effectively monitor and treat common comorbidities during SCI rehabilitation.

Keywords:

• Spinal cord injury
• Fatigue
• Pain
• Depression